Utility of Routine Intraoperative Cholangiogram during Cholecystectomy in Children: A Nationwide Analysis of Outcomes and Readmissions
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In brief
In brief
Nationwide analysis of 34,390 pediatric cholecystectomies demonstrates that routine intraoperative cholangiogram use is associated with significantly lower 30-day and 1-year readmission rates, fewer complications, and reduced bile duct injuries compared to cholecystectomy alone. Propensity-matched cohorts showed complication rates of 12% versus 22% and bile duct injury rates of 0% versus 2% favoring routine IOC use.
Written by the GCMD Library team from the article.
Abstract
Purpose
This study aims to determine postoperative outcomes and readmissions in pediatric cholecystectomy with routine intraoperative cholangiogram (IOC) utilization.
Methods
The Nationwide Readmissions Database 2010–2014 was queried for all pediatric cholecystectomies. A propensity score-matched analysis (PSMA) with over 30 covariates was performed between cholecystectomy alone (CCY) versus those with routine IOC (CCY + IOC, no biliary obstruction, dilatation, or pancreatitis). χ2 analysis or Mann-Whitney U were used for statistical analysis with p < 0.05 set as significant.
Results
34,390 cholecystectomies were performed: 92% were laparoscopic, most were teenage females (75%, 15 years [13–17]) and did not undergo IOC (75%). Postoperative mortality rate was 0.1%.
The PSMA cohort comprised of 1412 CCY and 1453 CCY + IOC. Patients with CCY alone had higher rates of 30-day (7% vs 5%), 1-year readmissions (13% vs 11%) and had higher rates of overall complications (22% vs 12%) compared with CCY + IOC, all p < 0.05. Although uncommon, bile duct injuries were more prevalent in CCY (2% vs 0%, p < 0.001), while there was no difference in readmissions for retained stones. Resource utilization was increased in CCY patients, likely due to increased complication rates.
Conclusion
This nationwide PSMA suggests pediatric CCY with routine IOC is associated with decreased readmissions, overall resource utilization, complications, and bile duct injuries.
Type of Study
Retrospective Comparative Study.
Level of Evidence
Level III.